Anesthesiology Digest – June 24, 2022

June 23, 2022

Anesthesiology Digest: News from June 2022.
New Class Action Lawsuit Claims Meta’s Discreet Patient Data Tracker Was Active Across 664 Provider Websites
By Dave Muoio | June 21, 2022

Facebook parent company Meta was hit with a class action lawsuit late last week alleging the tech company has been collecting sensitive patient-status data through hospital websites in violation of the Health Insurance Portability and Accountability Act (HIPAA).

The case was filed on Friday in the Northern District of California by an anonymous patient of Baltimore’s Medstar Health System on the behalf of “millions of other Americans whose medical privacy has been violated by Facebook’s Pixel tracking tool.”

The filing came just days after the publication of an investigation by The Markup detailing how the tech company’s analytics tool was found on roughly a third of the country’s top hospitals’ websites.

Both the report and the lawsuit detailed the tracker’s collection of identifiable information such as IP addresses alongside other potentially sensitive information including doctor names and recent web activity related to their health conditions. The two documents also said that patients using provider websites with the tracker would not have consented to the collection of these data.

While The Markup and experts cited in its group characterized the practices as a likely HIPAA violation, the class action was more explicit in its claims. “Facebook is aware that it is receiving patient data from hundreds of different medical providers in the United States without patient knowledge, consent or valid HIPAA authorizations,” the plaintiff wrote in the lawsuit.

The plaintiff also said that they have identified “at least 664 hospital systems or medical provider web properties where Facebook has received patient data via the Facebook Pixel” as of the Friday filing. To read more, go to Fierce Healthcare.  

Insurers Wrestle with Proposed Marketplace Rule
By Kara Hartnett | June 21, 2022

Insurers may soon be accountable for the health equity promises they make.
In recent years, insurance organizations and professional groups have committed to programs that address social determinants of health and promote diversity, equity and inclusion. Now, such initiatives could become the baseline.

Government entities are considering making the National Committee for Quality Assurance’s Health Equity Accreditation mandatory for Medicaid and marketplace plans, which would require insurers administering them to comply with new standards meant to eliminate disparities in the communities they serve.

Some states have already moved to enact the requirement, but insurers have pushed back against a federal mandate for marketplace issuers. They cite costly operational changes, overly broad guidance and unproven effectiveness as reasons to hold off from making accreditation a federal requirement.
Consumer advocacy groups and public entities, meanwhile, say the mandatory accreditation process is necessary to revamp practices that perpetuate inequality within the healthcare industry.

To read more, go to Modern Healthcare.
Hospitals Call Medicare Pay Proposal ‘Woefully Inadequate’
By Maya Goldman | June 20, 2022
The proposed Medicare payment update for inpatient services is nowhere close to covering hospitals’ rising costs, industry groups warn the Centers for Medicare and Medicaid Services in comment letters.

Hospitals are calling on CMS to make further upward adjustments to the fiscal 2023 inpatient prospective payment system rule to compensate for underpredictions from this fiscal year’s rule and to eliminate a separate negative adjustment for the coming year.

“The current inflationary economy combined with the COVID-19 crisis has put unprecedented pressure on America’s hospitals and health systems,” the American Hospital Association wrote. “These shifts in the healthcare environment are putting enormous strain on hospitals and health systems, which will continue in FY 2023 and beyond.”

CMS proposed a 3.2% increase in Medicare inpatient payments for fiscal 2023, including a 3.1% market basket update, in a draft regulation issued in April. The market basket predicts future hospital costs using data from prior years. CMS incorporated data through the third quarter of 2021, but may use more recent information in the final rule, according to the draft regulation.

The market basket can adequately predict cost trends in a more stable economy but it doesn’t work well under the present circumstances, the AHA wrote.
“The end of calendar year 2021 into calendar year 2022 should not, in any sense, be considered a steady-state economic environment that is a continuance of past trends,” the AHA wrote. Using these data would result in “woefully inadequate reimbursements,” the letter says.

Furthermore, the 2.7% fiscal 2022 inpatient payment update underpredicted costs, industry representatives wrote. The 2022 market basket is now trending toward 4%, hospital groups note, citing CMS projections. “Because this market basket was a forecast of what was expected to occur, it missed the unexpected trends that actually did occur,” the AHA wrote.

Inflation jumped from 2.6% in March 2021 to 7% in December. The 2022 market basket didn’t anticipate that factor nor increased labor costs during the second half of 2021, the AHA wrote. Inflation reached a 40-year high this spring, and could accelerate even further this summer, Fannie Mae projected this month.
Pressures from the COVID-19 pandemic also strained hospitals over the past two years. Federal relief stabilized hospital finances in 2020, but the funding is 
nearly depleted.

To read more, go to Modern Healthcare.
Hospitals Implore Congress to Punt Medicare Payment Cut Slated for July
By Dave Muoio | June 15, 2022

The American Hospital Association (AHA) penned a last-ditch letter to congressional leaders pleading for Medicare sequester cuts slated to take effect July 1 to be halted in light of the financial strain many of the nation’s hospitals are expected to face throughout 2022.

Congress had initially paused the 2% payment cut as part of the CARES Act when the COVID-19 pandemic began to threaten providers’ bottom lines. Sequestration cuts were continually punted downfield until last December, when a bill was signed to resume a 1% cut in April and the full 2% in July.
With half a month to go, AHA Executive Vice President Stacey Hughes warned majority and minority leaders Tuesday that financial relief from the pending cut is necessary for hospitals “to maintain access to care for the patients and communities they serve.”

Providers are still under the pressure of COVID-19 with higher expenses tied to labor costs and supply chain issues, Hughes wrote. Hospitals are also unable to absorb or deflect “historic inflation levels” as most of their payments come from Medicare and Medicaid’s nonnegotiable, fixed reimbursement rates, she said.
“All these factors have led to a historically poor first quarter financially for hospitals and health systems this year,” Hughes wrote. “And as recently as April, operating margins were down nearly 40% from the prior month.

“Without immediate action, the AHA estimates hospitals will lose at least $3 billion by the end of the year,” she wrote.

Hospital industry groups had hoped that another delay to the sequestration cuts could be included alongside other health priorities in omnibus spending bills passed earlier this year. In particular, the groups had noted that the decision to end the cuts came before hospitals faced their worst COVID-19 surge of the pandemic.

To read more, go to Fierce Healthcare.
Contact Congress today and tell them to STOP MEDICARE CUTS!

Anthem Revives Wellpoint Name in Rebranding Effort
By Nona Tepper | June 15, 2022
Anthem is continuing its corporate makeover.

The nation’s second largest insurer, which will change its name to Elevance Health on June 28, is extending its rebranding campaign, Anthem announced Wednesday. The company’s healthcare services arm will be dubbed Carelon and some of its health plans will take on the Wellpoint brand, which was the parent company’s name before it became Anthem in 2014. The divisional renaming will take place over the next few years.

In markets where Anthem does not own Blue Cross and Blue Shield plans, its Medicare, Medicaid and commercial insurance products will take on the Wellpoint moniker. The name change will not impact the Anthem Blue Cross and Blue Shield plans the company operates in 14 states.

To read more, go to Modern Healthcare.
AMA to Fight Legislation Expanding Scope of Practice
By Jessica Kim Cohen | June 14, 2022
The American Medical Association pledged to fight legislation that expands mid-level providers’ autonomy.

Under a new policy proposal adopted Tuesday by the AMA House of Delegates, the trade group will support research on the cost and quality of nurse practitioners, physician assistants and other advanced practice practitioners caring for patients without a doctor’s supervision. The association will help craft state legislation to oppose laws that expand the scope of practice for non-physicians and to reverse such laws that already exist.

The AMA convened delegates from groups including state and territorial medical associations and national specialty societies in Chicago this week to vote on a slate of policy proposals.

Expanding scope of practice has been a longstanding point of contention between physicians and advanced practice practitioners. Nurses have pointed to a number of studies that found no significant difference in care quality between APPs and physicians.

State legislators drafted more than 70 bills this year that would adjust scope-of-practice laws. Most of those bills sought to codify the relaxing of such laws during the COVID-19 pandemic, when physicians were occupied by the most acute cases. Currently, nearly half of states give nurse practitioners broad practice authority.

Mid-level providers prescribed antibiotics more frequently, ordered more imaging and provided more expensive care, according to research cited by the AMA.

While doctors at the meeting Tuesday agreed on the research proposal, they diverged on how the AMA should support state medical societies and whether the AMA should push to reverse existing legislation.

The AMA’s reference committee had suggested deleting the section calling for state legislation on reversing scope of practice laws. The trade group already has model legislation on related topics, like team-based care, which emphasizes coordinating care across providers and settings, the committee said.

To read more, go to Modern Healthcare.
Average Anesthesia Salary by State 2022
By Riz Hatton | June 13, 2022

The average annual salary for anesthesiologists in the U.S. is $226,000, according to career website Zippia, with the highest being in North Dakota and lowest in Hawaii.

The data used for the site’s ranking was last updated Feb. 9.

Here is the average anesthesiologist salary by state in alphabetical order and including Washington, D.C.:
Alabama: $189,261
Alaska: $186,832
Arizona: $181,327
Arkansas: $186,637
California: $183,471
Colorado: $184,933
Connecticut: $191,390
Delaware: $173,734
District of Columbia: $183,437
Florida: $166,317
To read more, go to Becker’s ASC.
Fines Kicking in After Slow Start to Hospital Transparency Rule
By Alex Kacik | June 9, 2022

Fewer than 6% of hospitals obeyed the price transparency rule during the early months of implementation, a new study shows.

Of the 5,239 hospitals studied, 13.9% had a machine-readable file but not a consumer-friendly display, 29.4% had a consumer-friendly display but no machine-readable file and only 5.7% had both, according to research published Tuesday in the Journal of the American Medical Association.
Hospitals in unconcentrated healthcare markets were more likely to comply with the rule compared with their counterparts in highly consolidated markets, the findings from July through September of last year show.

“Advocates of transparency have a fight on their hands, and those who want to keep their prices secret are highly motivated to do so,” Katherine Hempstead, a senior policy adviser at the nonprofit research group Robert Wood Johnson Foundation, said in an email, noting there are low consequences for hospitals that ignore the regulations or only partially comply.

“It is too bad that so far the public is not benefiting as intended from these hospital transparency regulations, but I do think those entities who may think they are winning this battle will ultimately lose the war,” she said. “Time is not on their side.”

To read more, go to Modern Healthcare.
Providers are Calling for More Time to Implement Estimate Requirement in Surprise Bill Rule
By Robert King | June 8, 2022

Providers have a little more than six months to find a way to deliver good faith estimates to patients on medical bills, but some say a lack of automated solutions is going to create a colossal burden for them to meet. 

Several groups have written to the Centers for Medicare & Medicaid Services (CMS) asking for more time to implement the good faith estimate portion of a rule that bans surprise medical bills. The rule, which is the subject of a broader legal fight with the healthcare industry, is set to take effect on Jan. 1, 2023.
“In light of the impending deadline and the to-date lack of guidance from CMS, we request an extension in enforcement discretion until a technical solution has been identified and implemented,” the American Hospital Association said in its letter to CMS.

The No Surprises Act signed into law last year calls for a ban on surprise medical bills and sets up an arbitration system to handle disputes between payers and providers over out-of-network charges. The law also requires providers to give uninsured or self-pay patients a “good faith estimate” of charges for care when a procedure is scheduled or upon request, according to CMS. Providers must also give estimates for certain insured patients to their plan or health insurer.
The law includes an arbitration process to handle charges that are well above the estimate.

Providers must start making these estimates available Jan. 1, but groups say the Department of Health and Human Services (HHS) has a massive misunderstanding of the infrastructure they are needed to meet the estimate requirements. 

To read more, go to Fierce Healthcare.
Legal Experts Expect ‘More Scrutiny’ of Medicare Prior Authorization From Feds
By Maya Goldman | June 6, 2022

As the federal government’s attention to improper Medicare Advantage prior authorization denials intensifies, insurers should consider examining their policies if they want to avoid trouble.

Hospitals have called on the Justice Department to use the False Claims Act against Medicare Advantage carriers that improperly deny coverage. Health insurance companies ought to take a closer look at their policies and how employees are trained to implement them, said Scott Stein, a partner at Sidley Austin and editor of the law firm’s False Claims Act blog. “I do suspect that there’s going to be a lot more scrutiny in this area,” Stein said.
The False Claims Act is generally enforced against providers that knowingly submit fraudulent claims to Medicare or Medicaid. Whether the statute also governs prior authorization denials is up for debate.

Even for situations in which it could apply, evidence that the denials and the appeals processes were so egregious that they go beyond contract violations would have to be strong, said Jason Christ, a healthcare fraud and abuse attorney at Epstein Becker Green.

But federal interest in Medicare Advantage enforcement follows a familiar pattern that often ends with the Justice Department getting involved.

“There’s a lot of ingredients here that you see before what I’ll call a ‘sweep,'” Christ said. “You always sort of look at: How interesting would something like this be to a finder-fact jury or a judge?”

The federal government has already voiced concerns about Medicare Advantage insurers upcoding diagnoses to inflate risk adjustment scores. The Justice Department intervened in a False Claims Act case against a health insurer last year.

To read more, go to Modern Healthcare.
2022 ASA Conversion Factor Survey
June 2, 2022
The American Society of Anesthesiologists invites you to participate in our 20th survey of commercial payment rates. As with previous surveys, we will publish the results in the ASA Monitor later this year.  While only those questions marked with an asterisk require a response to complete the survey, the optional questions offer insights into critical practice topics that help to inform ASA prioritize its efforts and create new and relevant materials. We would greatly appreciate your help with this update and hope you will complete it in its entirety.

As a reminder, the Statements of Antitrust Enforcement Policy in Health Care issued jointly by the Department of Justice and the Federal Trade Commission make it possible for us to gather this information as long as certain conditions are met. The most important condition, besides only publishing aggregate statistics, is that the data you provide be AT LEAST THREE MONTHS OLD.

Please provide the following information for your FIVE (5) highest-volume commercial payers (NOT MEDICARE, MEDICAID, OTHER GOVERNMENT PAYERS) based on volume of services provided on an annual basis. If you have fewer than five contracted commercial payers, please enter information for all of your commercial payers. AGAIN, PLEASE ENSURE YOUR DATA IS AT LEAST THREE MONTHS OLD.

TO OUR ANESTHESIOLOGISTS: Please ask your practice manager or billing service to complete this questionnaire. It is important that we receive only one response from each anesthesia group. We ask that you or your staff complete the survey NO LATER THAN JULY 8, 2022.
The survey is available here.
Drug Shortages Continue…And Proliferate
June 2, 2022

Many medications commonly used by anesthesiologists and pain medicine specialists are in serious shortage, according to an American Society of Health-System Pharmacists (ASHP) member survey (

“Although I am not surprised by the drug shortages that are affecting anesthesiologists and pain medicine specialists, I am quite alarmed by the impact these shortages are having,” said principal investigator Michael Ganio, PharmD, a senior director of pharmacy practice and quality for ASHP, in Bethesda, Md. “Drug shortages have been problematic for 20 years now, but we had been doing fairly well until recent years.”

Ganio noted that Hurricane Maria had caused shortages of some saline products and sterile water in Puerto Rico in 2017. “We then did better until the COVID-19 pandemic hit,” he said. “We had problems securing anesthesiology medications and drugs for ventilators. Then things seemed to improve some. But now, with supply chain issues and workforce challenges, drug shortages are becoming very prevalent again.”
The survey, conducted in March 2022, was inspired by anecdotal reports of drug shortages by ASHP members and an increase in the number of reports of shortages in the ASHP service database. “There was also an overall concern for the availability of some of these products,” Ganio said.

Of the 345 respondents, most worked primarily in a hospital setting. More than 99% of participants reported being negatively affected by shortages of critical drugs.

To read more, go to Anesthesiology News.
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